Expandable metal stents:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa. [u.a.]
Saunders
1999
|
| Schriftenreihe: | Gastrointestinal endoscopy clinics of North America
9,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVIII S., S. 359 - 558 Ill., graph. Darst. |
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| 650 | 2 | |a Stent | |
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Datensatz im Suchindex
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| adam_text | EXPANDABLE METAL STENTS
CONTENTS
Foreword xv
Charles J. Lightdale
Preface xvii
David L. Carr Locke
Human Tissue Responses to Metal Stents 359
Nimish Vakil, Ulrich Gross, and Norbert Bethge
Metal stents have become an important addition to therapeutic
strategies available for incurable gastrointestinal malignancies. The
responses of human tissues to the presence of metal stents are
important for several reasons. The first is to understand the mecha¬
nism by which stents are anchored in the stenosis, as this will
prevent migration of stents. The second is to develop new designs
of stents that would be removable. The third reason is to prevent
complications of stents, such as benign hypertrophy at the proximal
and distal ends of the stent, and to understand the mechanism of
serious complications, such as migration through the esophageal
wall or aortoesophageal fistula. In this article, the authors discuss
the state of the current knowledge in these three areas.
Commercial Devices in the United States
The Z Stent 367
Gregory J. Skerven and Brenda Spain Stewart
Z stents were originally designed to relieve upper or lower vena
cava obstructions. In time, they were adapted to be somewhat
GASTROINTESTINAL ENDOSCOPY
CLINICS OF NORTH AMERICA
VOLUME 9 • NUMBER 3 • JULY 1999 vii
flexible, yet keep their position. This article presents information
on the technology behind the Z stent, placement of the Wilson
Cook Z stent, and future manufacturer developments.
The Wallstent Endoprosthesis 373
Brian E. Mclntee
The Wallstent endoprosthesis is the most widely used self
expanding metal stent for treating digestive disease worldwide.
This article presents detailed metallurgical and physical informa¬
tion on the Wallstent endoprosthesis, and addresses implications
for its clinical use. Detailed product information provides technical
insight into the implantable stent and associated delivery systems.
Current worldwide product indications and configurations are dis¬
cussed, as well as insight into new products in clinical evaluation.
The Ultraflex Esophageal and Diamond Biliary Stents 383
David Hoffman
This article begins with an overview of the history and develop¬
ment of stents. The material properties unique to the Ultraflex
esophageal stent and the Diamond biliary stent along with their
clinical benefits are presented in detail. The author also provides
detailed product information, recommendations, and contraindica¬
tions for the use of both stents.
Malignant Esophageal Obstruction
Z Stent for Malignant Esophageal Obstruction 395
Emad Y. Rahmani, Douglas K. Rex, and Glen A. Lehman
The Z stent was one of the first self expanding metal prostheses
used for palliation of malignant esophageal obstruction and respi¬
ratory esophageal fistula. Its placement has proved to be effective
and relatively safe. This article reviews the evolution of the Z
stent; its multiple designs, placement technique, efficacy, complica¬
tions, and assets and limitations.
The Wallstent I and II for Malignant
Esophageal Obstruction 403
Douglas Nelson
The Wallstent I and II esophageal endoprostheses are effective in
the palliation of malignant esophageal obstruction and the closure
of digestive respiratory fistulas. The author reviews the evolution
of the Wallstent esophageal endoprosthesis and techniques for
successful insertion, and summarizes the published literature with
regard to clinical outcomes of the European and American Wall¬
stent designs.
Viii CONTENTS
The Ultraflex Stents for Malignant
Esophageal Obstruction 413
Mahesh S. Mokhashi and Robert H. Hawes
Ultraflex esophageal stents have contributed to the tremendous
success of self expanding metal stents (SEMS) in the treatment of
esophageal cancer because they are easy and safe to insert. With
an eye to improving clinical outcome, the Ultraflex stent design
has been in a state of constant evolution since its introduction.
However, as with other SEMS, a high reintervention rate remains
a challenging problem.
The Esophacoil Stent for Malignant
Esophageal Obstruction 423
William Mayoral and David E. Fleischer
Esophageal cancer is the seventh most common cause of cancer
related deaths in men in the United States. For a disease in which
60% of patients are incurable at presentation, palliative therapy is
the main treatment option. Palliative measures include surgery,
radiation therapy, chemotherapy, photodynamic therapy, endo
scopic dilation, endoscopic ablation, and the use of endoscopic
prostheses. This article reviews the characteristics, technique, effi¬
cacy, and complications of the Esophacoil stent for malignant
esophageal strictures.
The Radiologist s View of Expandable Metallic Stents
for Malignant Esophageal Obstruction 431
Robert Morgan and Andy Adam
Interventional radiologists place esophageal stents with great accu¬
racy and low complication rates. The results of radiologic place¬
ment are similar to endoscopic stent insertion. The advantages of
radiologic stent insertion are the ability to traverse very small
strictures that cannot be crossed endoscopically and the ability
to visualize and treat small fistulae and perforations at the time
of stenting.
Expandable Metal Stents for Benign
Esophageal Obstruction 437
Gurpal S. Sandha and Norman E. Marcon
Extensive experience with expandable metal stents for benign
esophageal obstruction is limited. A review of the literature demon¬
strates a high incidence of complications varying from stent migra¬
tion to stent induced trauma leading to fistulization. The most
common complication (41%) is that of stent induced stenosis
caused by granulation tissue and fibrosis. Currently, the authors
do not recommend the routine use of expandable metal stents for
CONTENTS ix
benign obstruction. Each case must be assessed on its own merits
and risks. The solution in the future may well have to be new stent
configuration and esophagus friendly materials.
Expandable Metal Stents for Gastric Outlet, Duodenal,
and Small Intestinal Obstruction 447
Roy M. Soetikno and David L. Carr Locke
The treatment of patients who have malignant gastric outlet, duo¬
denal and small intestinal obstructions is difficult. The morbidity
and mortality of palliative surgery in these patients is significant.
It is not uncommon for patients to be treated with supportive
therapy only, which unfortunately, neither relieves the severe nau¬
sea and vomiting, nor allows adequate food intake. Over the past
few years, a number of studies have reported the safety and efficacy
of self expanding metal stents used to palliate malignant upper
gastrointestinal obstruction. In this article, the authors focus on the
use of self expanding metal stents to treat malignant gastric outlet,
duodenal, and small intestinal obstructions.
Metallic Stenting for Colorectal Obstruction 459
Simon K. Lo
Intestinal obstruction is a major complication of colorectal cancer.
Acute surgical decompression frequently requires subsequent op¬
erative interventions and is associated with mortality in more than
3% of the cases. Transanal metallic stenting is now possible to
perform on an outpatient basis, thus providing quick symptom
relief and the opportunity to cleanse the bowel for work up or
surgery. This stenting provides temporary relief for patients and
is gaining acceptance rapidly. Randomized controlled trials are
needed to help pinpoint refinements that can minimize the diffi¬
culty of stent insertion.
Biliary Obstruction
Endoscopically Placed Gianturco Endoprosthesis in the
Treatment of Malignant and Benign Biliary Obstruction 479
Douglas A. Howell, Steven F. Nezhad, and Robert M. Dy
Since the introduction of the Z stent by Cesare Gianturco in 1985,
the prominent role of endoscopically placed transpapillary endo
prostheses as the treatment of choice to relieve malignant biliary
obstruction has stimulated much interest and research in the evolu¬
tion of his initial design. This article reviews the efficacy and limita¬
tion of prior Z stent models in their attempt to relieve malignant
and benign biliary obstructions and previews improvements in the
design currently being evaluated in a large, multicenter trial.
X CONTENTS
The Wallstent for Malignant Biliary Obstruction 491
Kees Huibregtse
The self expandable metal Wallstent was introduced in late 1980
for the treatment of malignant biliary strictures. The technique of
insertion in distal and hilar bile duct strictures is described in
detail. The author presents the reported data and discusses the
indications for the stent s use. This stent still does not fulfill all the
criteria for an ideal stent; further improvements should be made.
The Endocoil Stent for Malignant Biliary Obstruction 503
John C. Cozart and Gregory B. Haber
The Endocoil (Instent, Inc., Eden Prairie, MN), first introduced in
1993, is a self expandable nitinol stent made of a coil spring of
nickel titanium alloy. Advantages of the Endocoil in patients with
malignant biliary obstruction were thought to include increased
radial force with more rapid stricture dilation, inhibition of tumor
ingrowth caused by the stent s coil framework with closed approxi¬
mation of loops, and the possibility for endoscopic removal. Unfor¬
tunately, in subsequent reports of patients undergoing Endocoil
placement, there have been significant problems with incomplete
expansion or twisting during deployment, stent migration, and
tumor ingrowth. This article reviews the available literature regard¬
ing Endocoil placement for malignant biliary obstruction and ad¬
dresses the authors experience at a tertiary referral center.
The Ultraflex Diamond Stent for Malignant
Biliary Obstruction 513
Jean Marc Dumonceau and Jacques Deviere
The Ultraflex Diamond stent presents three features that might be
of interest when treating biliary strictures: ease of insertion, high
flexibility, and presentation of relatively large meshes. Limited
clinical studies have shown its efficacy in relieving duct obstruction
(in contrast with some other stent models, correct positioning of
the Ultraflex Diamond stent provides adequate biliary drainage in
almost all cases), and satisfactory long term patency rates. The
main improvement awaited is an efficient means to prevent late
stent obstruction. The addition of coverage to this stent is feasible
and could be the first step toward this goal.
The Wallstent for Benign Biliary Obstruction 521
Isaac Raijman
Endoscopic stent placement for biliary strictures is well established.
The majority of biliary strictures, particularly benign, are treated
with plastic stents. The role of permanent expandable stents in the
treatment of benign biliary strictures is still questionable. When
expandable stents are used, it appears that those with a wider
mesh have a better long term response. In this article, the authors
present data on the Wallstent for benign biliary strictures.
CONTENTS xi
The Endocoil for Benign Biliary Obstruction 533
Rohan J. H. Hammett
This article evaluates the use of the Endocoil in patients with benign
biliary obstruction. It contains detailed information regarding the
practicalities of insertion and retrieval of the Endocoil stent and
examines the evidence for its use in this group of patients. The
author discusses complications and how to avoid them, and pro¬
vides recommendations for the future use of the Endocoil.
The Ultraflex Diamond Stent for Benign
Biliary Obstruction 541
Jean Marc Dumonceau, Nicole Nicaise,
and Jacques Deviere
The most frequent type of benign bile duct stricture (BBDS) that
complicates surgery, is not an indication for placement of any
current model of metal stent because of poor long term results.
This statement could not apply to less frequent types of BBDSs,
in particular those complicating chronic pancreatitis (CP) and ra¬
diotherapy. The authors report their preliminary results observed
in 10 patients whose CP related BBDS was treated with an Ultraflex
Diamond stent. No stent dysfunction was detected in the observed
patients during a mean follow up of 17 months. Studies involving
larger numbers of patients followed for longer periods of time are
necessary to know whether endoscopy using this material may
replace surgery in this indication.
Expandable Metal Stents for Benign Pancreatic
Duct Obstruction 547
Pierre Eisendrath and Jacques Deviere
Among patients with advanced chronic pancreatitis and morpho¬
logically demonstrable main pancreatic duct (MPD) abnormalities
who are candidates for endotherapy, about two thirds have a MPD
stricture and require stenting to achieve appropriate ductal decom¬
pression. The standard stent used in this indication is the plastic
stent, which provides a median patency rate of 6 to 12 months.
The requirement for stent exchange represents a limitation for the
treatment of this relatively young patient population. By analogy
with the biliary tract, the authors hypothesize that self expandable
metal stents might offer a long lasting drainage of the MPD. Several
years ago the authors used such stents on an experimental basis
to treat patients with MPD strictures. Although routine use of
self expandable metal stents should be discouraged, the authors
propose some guidelines for further technical improvement.
Index 555
Subscription Information Inside back cover
Xii CONTENTS
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| physical | XVIII S., S. 359 - 558 Ill., graph. Darst. |
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| series | Gastrointestinal endoscopy clinics of North America |
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| spelling | Expandable metal stents David L. Carr-Locke, guest ed. Philadelphia, Pa. [u.a.] Saunders 1999 XVIII S., S. 359 - 558 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gastrointestinal endoscopy clinics of North America 9,3 Oesophage, maladies - Thérapeutique Stent Voies biliaires, maladies - Thérapeutique Gastrointestinal system Stents (Surgery) Darmstenose (DE-588)4337410-4 gnd rswk-swf Stenose (DE-588)4136810-1 gnd rswk-swf Gallengang (DE-588)4071547-4 gnd rswk-swf Stent (DE-588)4562973-0 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Ösophagustenose gnd rswk-swf Darmstenose (DE-588)4337410-4 s Stent (DE-588)4562973-0 s DE-604 Ösophagustenose f Gallengang (DE-588)4071547-4 s Stenose (DE-588)4136810-1 s Carr-Locke, David L. Sonstige oth Gastrointestinal endoscopy clinics of North America 9,3 (DE-604)BV005455484 9,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008651200&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Expandable metal stents Gastrointestinal endoscopy clinics of North America Oesophage, maladies - Thérapeutique Stent Voies biliaires, maladies - Thérapeutique Gastrointestinal system Stents (Surgery) Darmstenose (DE-588)4337410-4 gnd Stenose (DE-588)4136810-1 gnd Gallengang (DE-588)4071547-4 gnd Stent (DE-588)4562973-0 gnd |
| subject_GND | (DE-588)4337410-4 (DE-588)4136810-1 (DE-588)4071547-4 (DE-588)4562973-0 (DE-588)4143413-4 |
| title | Expandable metal stents |
| title_auth | Expandable metal stents |
| title_exact_search | Expandable metal stents |
| title_full | Expandable metal stents David L. Carr-Locke, guest ed. |
| title_fullStr | Expandable metal stents David L. Carr-Locke, guest ed. |
| title_full_unstemmed | Expandable metal stents David L. Carr-Locke, guest ed. |
| title_short | Expandable metal stents |
| title_sort | expandable metal stents |
| topic | Oesophage, maladies - Thérapeutique Stent Voies biliaires, maladies - Thérapeutique Gastrointestinal system Stents (Surgery) Darmstenose (DE-588)4337410-4 gnd Stenose (DE-588)4136810-1 gnd Gallengang (DE-588)4071547-4 gnd Stent (DE-588)4562973-0 gnd |
| topic_facet | Oesophage, maladies - Thérapeutique Stent Voies biliaires, maladies - Thérapeutique Gastrointestinal system Stents (Surgery) Darmstenose Stenose Gallengang Aufsatzsammlung Ösophagustenose |
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